Healthcare Provider Details

I. General information

NPI: 1780819292
Provider Name (Legal Business Name): HEATHER LEAH BRISCOE HEATHER BRISCOE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 CALIFORNIA ST
SAN FRANCISCO CA
94118-1502
US

IV. Provider business mailing address

3850 CALIFORNIA ST
SAN FRANCISCO CA
94118-1502
US

V. Phone/Fax

Practice location:
  • Phone: 415-750-6228
  • Fax:
Mailing address:
  • Phone: 415-750-6228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA107391
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: